A new meta-analysis of the efficacy of cognitive behavioral therapy (CBT) compared to other therapies found that CBT did not outperform other psychotherapies in the treatment of depression.
MARK RUFFALO; mlruffalo@gmail.com
Ruffalo is an instructor of psychiatry at the University of Central Florida College of Medicine and an adjunct instructor of psychiatry at Tufts University School of Medicine.
JONATHAN SHEDLER; jonathan@shedler.com
Shedler is a psychologist. He is best known for his article The Efficacy of Psychodynamic Psychotherapy, which established psychoanalytic therapy as an evidence-based treatment.
Ruffalo told the Institute for Public Accuracy: “This is not the first meta-analysis of the effects of CBT for depression [versus] other therapies, but it is the largest ever of a specific type of psychotherapy for a mental disorder––409 studies and over 50,000 patients, which is an astronomical amount. Although CBT’s effectiveness for depression was confirmed, CBT did not outperform other psychotherapies, despite the fact that CBT leaders have touted it as the ‘gold standard’ therapy for depression” for decades. “The public has come to believe CBT is better than anything else, including psychodynamic therapy, which is simply not true. Other forms of psychotherapy, including more traditional forms of talk therapy, are also evidence-based treatments, despite claims of some CBT proponents.”
CBT proponents have long held authority in the mental health space in part due to the influence of managed care on the practice of psychotherapy, Ruffalo noted. “Health insurers want to cover only the briefest and cheapest treatments,” including CBT. “When the early CBT research showed it to be effective for depression, insurers began insisting on it versus other therapies.” This study only looks at treatment durations of under 16 sessions. But Shedler noted that “we know from previous research [treatments of 16 sessions] are over before meaningful psychological change can start to happen.”
Today, there is still “little research funding to study psychodynamic psychotherapy; most researchers in academic psychology lack exposure to psychodynamic ideas and have an anti-psychodynamic bias,” Ruffalo added. This creates barriers to researching the effectiveness of psychodynamic therapies.
Shedler said that the paper’s findings line up with his previous work: “Only about 20 percent of patients respond to the [CBT] treatments compared to those in control groups. At 10-12 months out [from treatment], that figure drops to about 6 percent.”